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Table 1 Description and source of the five components that constitute the BC Pediatric Early Warning System (BC PEWS)

From: Implementation study of a 5-component pediatric early warning system (PEWS) in an emergency department in British Columbia, Canada, to inform provincial scale up

 Pediatric assessment flowsheetThe double-sided flowsheet, designed for inpatients, comprehensively outlines documentation for 24 h of nursing assessment, including PEWS scoring parameters, full head-to-toe assessment and documentation of routine nursing care.Adapted from BC Children’s Hospital
The flow sheets are available in six age grouping (0–3 months; 4–11 months; 1–3 years; 4–6 years; 7–11 years and 12+ years) to account for naturally-occurring variations vital signs norms [14]. Staff were also provided with vital signs reference cards that could be worn on a lanyard.CTAS [14]
 PEWS scoreThe Brighton PEWS score embedded in the flowsheet is the most widely used and validated PEWS score available for inpatient care. It is a 13-point score (with 0 normal and 13 high risk) based on behavioural, cardiovascular and respiratory parameters.Brighton PEWS score [15]
As the Brighton scoring tool is not age specific, vital signs references for PEWS scoring were based on the Canadian Triage Acuity Scale (CTAS) vital signs norms [14, 17]. These norms were chosen to promote internal consistency within and between sites based on a nationally accepted standard. The PEWS scoring section of the flowsheet has the norms embedded for easy plotting and is colour coded to provide a clear visual when vital signs are outside of the normal range.CTAS [14], Fleming et al. [17]
 Situational awarenessThe intent of situational awareness is to promote awareness, prediction, and mitigation of potential risk. Implemented tools in the ED setting included posters for visual cueing, discussion in staff reporting and regular documentation of four factors embedded in the flowsheet (caregiver concern, unusual therapy, watcher patient, and communication breakdown).Adapted from the Cincinnati Situational Awareness Model [2]
 Escalation aidThe escalation aid outlines actions to support clinical decision making following assessment. Recommended mitigation actions (e.g. notification, reassessment, consultation) correspond to PEWS scores and situational awareness factors. A quick-view of the escalation aid was also embedded in the flowsheet.Adapted from Cook Children’s Medical Center
 Communication frameworkThe Situation, Background, Assessment, Recommendation (SBAR) toolkit was used to improve communication between team members regarding patient status.SBAR toolkit [16]